Research:
Our department was a part of the below mentioned multi centred trial held in year 2017.
A prospective, multi-center, open-label, single-arm phase 2b study of autologous adult live cultured buccal epithelial cells (AALBEC) in the treatment of urethral stricture"
According to this prospective study patients with urethral stricture were treated with innovative use of autologous adult live cultured buccal epithelial cells. This trial has been approved by ICMR and has been given permission to perform pilot study.
PUBLICATIONS LIST FROM 2011-2021
1.Bilateral single-system ectopic ureters opening into vaginalized urogenital sinus
Abstract
A 5-year-old female presented with continuous dribbling of urine without any voiding stream since birth. Upon investigations, the bladder neck and both ureters were opening into the vaginalized urogenital sinus and the urethra was absent. Coarctation of the aorta was an associated anomaly. To our knowledge, this is the first report in literature of bilateral single-system ectopic ureters opening into vaginalized urogenital sinus. The report highlights the necessity for consideration of continent diversion in such cases because of the absence of the urethra in addition to an incontinent bladder neck and tiny dysfunctional bladder.
Keywords: Ectopic ureter, ureter, urogenital sinus
Singh BP, Pathak HR, Andankar MG. Bilateral single-system ectopic ureters opening into vaginalized urogenital sinus. Indian journal of urology: IJU: journal ofthe Urological Society of India. 2010 Jan;26(1):126.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878426/
2.Impact of Prior Urethral Manipulation on Outcome of Anastomotic Urethroplasty for Post-traumatic Urethral Stricture
Objective
To determine the impact of earlier urethral interventions on the outcomes of anastomotic urethroplasty in post-traumatic stricture urethra.
Methods
From October 1995 to March 2008, a total of 58 patients with post-traumatic posterior urethral stricture underwent anastomotic urethroplasty. Eighteen patients had earlier undergone urethral intervention in the form of urethrotomy (3), endoscopic realignment (7), or open urethroplasty (8). Success was defined as no obstructive urinary symptoms, maximum urine flow rate 15 mL/s, normal urethral imaging and/or urethroscopy, and no need of any intervention in the follow-up period. Patients who met the above objective criteria after needing 1 urethrotomy following urethroplasty were defined to have satisfactory outcome and were included in satisfactory result rate along with patients who had a successful outcome. Results were analyzed using unpaired t test, chi-square test, binary logistic regression, Kaplan Meier curves, and log rank test.
Results
Previous interventions in the form of endoscopic realignment or urethroplasty have significant adverse effect on the success rate of subsequent anastomotic urethroplasty for post-traumatic posterior urethral strictures (P <.05). Previous intervention in the form of visual internal urethrotomies (up to 2 times) did not affect the outcome of subsequent anastomotic urethroplasty. Length of stricture and age of patient did not predict the outcome in traumatic posterior urethral strictures in logistic regression analysis.
Conclusions
Previous failed railroading or urethroplasty significantly decrease the success of subsequent anastomotic urethroplasty. Hence, a primary realignment or urethroplasty should be avoided in suboptimal conditions and the cases of post-traumatic urethral stricture should be referred to centers with such expertise.
Singh BP, Andankar MG, Swain SK, Das K, Dassi V, Kaswan HK, Agrawal V, Pathak HR. Impact of prior urethral manipulation on outcome of anastomotic urethroplasty for post-traumatic urethral stricture. Urology. 2010 Jan 1;75(1):179-82.
https://www.sciencedirect.com/science/article/abs/pii/S0090429509022146
3.Factors Predicting Success in Hypospadias Repair Using Preputial Flap With Limited Pedicle Mobilization (Asopa Procedure)
Objectives
To analyze the objective factors determining success in hypospadias repair by the Asopa technique of limited preputial pedicle mobilization.
Methods
This was a prospective study involving a cohort of 48 patients (age range 1-19 years) who underwent hypospadias repair in a tertiary care teaching institution, with a follow-up of 20-58 months. Patient inclusion criteria were absence of past history of any local surgery with urethral plate less than 6 mm and hooded prepuce.
Results
At a median follow-up of 33.5 months, the overall complication and fistula rates were 22.9% and 16.7%. Complication and fistula rates were 40% and 30% with tube repairs vs. 18.4% and 13.2% with onlay repairs.
Conclusions
In patients unsuitable for Snodgrass repair, the Asopa technique of transverse preputial flap repair provides reasonably good results. Patients with proximal hypospadias, conical glans configuration, tube repairs, and more advanced age had higher complication rates with transverse preputial flap repair.
Singh BP, Solanki FS, Kapoor R, Dassi V, Kaswan HK, Agrawal V, Swain SK, Andankar MG, Pathak HR. Factors predicting success in hypospadias repair using preputial flap with limited pedicle mobilization (Asopa procedure). Urology. 2010 Jul 1;76(1):92-6.
https://www.sciencedirect.com/science/article/abs/pii/S0090429510000713
4.Transurethral resection of prostate: a comparison of standard monopolar versus bipolar saline resection
INTRODUCTION: Transurethral resection syndrome is an uncommon but potentially life threatening complication. Various irrigating solutions have been used, normal saline being the most physiological. The recent availability of bipolar cautery has permitted the use of normal saline irrigation. MATERIAL ANDMETHODS: In a randomized prospective study, we compared the safety and efficacy of bipolar cautery (using 0.9% normal saline irrigation) versus conventional monopolar cautery (using 1.5% glycine irrigation). Pre and postoperative hemoglobin (Hb) and hematocrit values were compared. Hemodynamics and arterial oxygen saturation were monitored throughout the study. Safety end points were changes in serum electrolytes, osmolarity and Hb/PCV (packed cell volume). Efficacy parameters were the International Prostate Symptom Score (IPSS) and Qmax (maximum flow rate in mL/sec) values. RESULTS: Mean preoperative prostate size on ultrasound was 60 20cc. Mean resected weight was 17.6 10.8 g (glycine) and 18.66 12.1 g (saline). Mean resection time was 56.76 14.51 min (glycine) and 55.1 13.3 min (saline). The monopolar glycine group showed a greater decline in serum sodium and osmolarity (4.12 meq/L and 5.14 mosmol/L) compared to the bipolar saline group (1.25 meq/L and 0.43 mosmol/L). However, this was not considered statistically significant. The monopolar glycine group showed a statistically significant decline in Hb and PCV (0.97 gm %, 2.83, p < 0.005) as compared to the bipolar saline group (0.55 gm % and 1.62, p < 0.05). Patient follow- up (1,3,6 and 12 months postoperatively) demonstrated an improvement in IPSS and Qmax in both the groups. CONCLUSION: We concluded that bipolar transurethral resection of prostate is clinically comparable to monopolar transurethral resection of prostate with an improved safety profile. However, larger number of patients with longer follow up is essential.Singhania P, Nandini D, Sarita F, Hemant P, Hemalata I. Transurethral resection of prostate: a comparison of standard monopolar versus bipolar saline resection. International braz j urol. 2010;36:183-9.
https://www.scielo.br/j/ibju/a/7pTKm7NP9J5dr4F4dTLCJqv/abstract/format=html&lang=en
5.Factors Predicting Success in Hypospadias Repair Using Preputial Flap With Limited Pedicle Mobilization (Asopa Procedure)
Objectives
To analyze the objective factors determining success in hypospadias repair by the Asopa technique of limited preputial pedicle mobilization.
Methods
This was a prospective study involving a cohort of 48 patients (age range 1-19 years) who underwent hypospadias repair in a tertiary care teaching institution, with a follow-up of 20-58 months. Patient inclusion criteria were absence of past history of any local surgery with urethral plate less than 6 mm and hooded prepuce.
Results
At a median follow-up of 33.5 months, the overall complication and fistula rates were 22.9% and 16.7%. Complication and fistula rates were 40% and 30% with tube repairs vs. 18.4% and 13.2% with onlay repairs.
Conclusions
In patients unsuitable for Snodgrass repair, the Asopa technique of transverse preputial flap repair provides reasonably good results. Patients with proximal hypospadias, conical glans configuration, tube repairs, and more advanced age had higher complication rates with transverse preputial flap repair.
Singh BP, Solanki FS, Kapoor R, Dassi V, Kaswan HK, Agrawal V, Swain SK, Andankar MG, Pathak HR. Factors predicting success in hypospadias repair using preputial flap with limited pedicle mobilization (Asopa procedure). Urology. 2010 Jul 1;76(1):92-6.
https://www.sciencedirect.com/science/article/abs/pii/S0090429510000713
6.Early versus delayed presentation of posterior urethral valves in children: Consequences and outcome of vesico-ureteric reflux
Abstract
Introduction: Delayed presentation of patients with posterior urethral valve (PUV) is common in our country and is usually associated with complications and morbidities. Objective: To determine the pattern of presentation of PUVs and its complications and outcomes in these patients with respect to decrease or
resolution of vesico-ureteric reflux (VUR) and/or requirement of additional operative procedures. Materials and Methods: A retrospective study was conducted, and 30 children of PUV were analyzed with respect to the pattern of presentation, duration of symptoms, age at primary fulguration, grade of VUR and its outcome. Results: Patients with early presentation were diagnosed early, had their PUV fulgurated early and had lesser grades and better resolution of their VUR and good outcome. The reverse was seen in those patients who presented late and already had some form of renal impairment such as higher and bilateral grades of VUR and higher serum creatinine levels. Some of them also required additional procedures which added to their morbidity. Discussion: Delayed presentation of PUV is common in our country and is associated with an increased incidence and a higher grade of VUR which does not decrease or resolve on follow-up and usually requires additional operative interventions adding to the morbidity of both the parents and the child. On the other hand, early presentation leads to early diagnosis and early relief of obstruction and is associated with lesser VUR, which resolves over time. Conclusion: With early presentation, diagnosis and treatment, the outcome of patients with PUVs is expected to improve. Efforts at improving awareness and early diagnosis and referral among the health team should be encouraged.
Keywords: Posterior urethral valves, re-implantation, serum creatinine, ureterostomies, vesico-ureteric reflux
Sharma A, Shaikh I, Chaudhari R, Andankar M, Pathak H. Early versus delayed presentation of posterior urethral valves in children: Consequences and outcome of vesico-ureteric reflux. Saudi Surg J 2015;3:61-4
https://www.saudisurgj.org/article.aspissn=2320-3846;year=2015;volume=3;issue=3;spage=61;epage=64;aulast=Sharma
7.Anterior urethral valve, a rare cause of bilateral vesicoureteral reflux in a two yearold boy: A case report and a review of the literature
Amit Sharma, Radhyeshyam Chaudhari, Mukund Andankar
Abstract: Anterior urethral valve (AUV) is a rare cause of obstructive uropathy in children. These are much rarer than posterior urethral valves. We report a case of a child with AUV and high grade bilateral vesicoureteric reflux. He was managed by transurethral laser ablation. The left sided reflux resolved after ablation. The right sided reflux persisted. The child is awaiting ureteric reimplantation.
Keywords Anterior urethral valve; vesicoureteral reflux; obstructive uropathy; valve ablation; children.
Sharma A, Chaudhari R, Andankar M, Pathak H. Anterior urethral valve, a rare cause of bilateral vesicoureteral reflux in a two year old boy: A case report and a review of the literature. Ped Urol Case Rep. 2016 Apr 4;3(3):56-62.
https://pdfs.semanticscholar.org/00ec/92563697d2b9fcbfd62dc2f0a10ea126c4d0.pdf
8.Sarcoma of Prostate of Myofibroblastic Origin
Abstract
Sarcoma of prostate is a rare tumor wherein entire literature is based on few case reports and isolated case series. We hereby report a case of prostatic sarcoma of myofibroblastic origin that had come to our hospital with review of literature.
Keywords
Hematuria, Lower Urinary Tract Symptoms, Prostatic Neoplasms, Rhabdomyosarcoma, Sarcoma.
Jain TP, Bhujbal SA, Pathak HR. Sarcoma of prostate of myofibroblastic origin. Journal of Case Reports. 2015 Nov 7;5(2):463-6.
http://www.casereports.in/articles/5/2/Sarcoma-of-Prostate-of-Myofibroblastic-Origin.html
9.Two cases of retained ureteral stents presenting with breakage and encrustations
Ureteral stents (Double J stents) have become an integral part of today's urologic practice. But complications like stent migration, encrustation, stone formation and fragmentation have been found when these stents are kept for prolonged period. So, it is mandatory that these stents should be removed as early as possible to prevent complications and morbidity. We report two patients with broken retained DJ stents with encrustations and calcification.Sharma A, Andankar M, Pathak H. Two cases of retained ureteral stents presenting with breakage and encrustations. International Journal of Medical Research & Health Sciences. 2018;5(10):208-12.
https://www.indianjournals.com/ijor.aspxtarget=ijor:ijmrhs&volume=5&issue=10&article=035
10.A rare presentation of cystic nephroma in a young adult
Abstract
Cystic nephroma is a rare benign renal lesion with non-specific presenting symptoms. This tumour has a bimodal age distribution presenting in children between 3 months and 2 years and in adults over 30 years of age. There is male preponderance with a 2:1 male to female ratio in the childhood whereas it is commoner in females in adults. It is uncommon in the age-group of 5 years 30 years. We describe a case of cystic nephroma in a 25-year-old femalewhich was managed by partial nephrectomy.
Sharma A, Andankar M, Pathak H. A rare presentation of cystic nephroma in a young adult. Asian journal of urology. 2017 Apr 1;4(2):128-30.
https://www.sciencedirect.com/science/article/pii/S2214388217300012
11.Anterior urethral valve, a rare cause of bilateral vesicoureteral reflux in a two year old boy: A case report and a review of the literature
Abstract: Anterior urethral valve (AUV) is a rare cause of obstructive uropathy inchildren. These are much rarer than posterior urethral valves. We report a case of a child with AUV and high grade bilateral vesicoureteric reflux. He was managed by transurethral laser ablation. The left sided reflux resolved after ablation. The right sided reflux persisted. The child is awaiting ureteric reimplantation.
Keywords: Anterior urethral valve; vesicoureteral reflux; obstructive uropathy; valve ablation; children.
Sharma A, Chaudhari R, Andankar M, Pathak H. Anterior urethral valve, a rare cause of bilateral vesicoureteral reflux in a two year old boy: A case report and a review of the literature. Ped Urol Case Rep. 2016 Apr 4;3(3):56-62.
https://pdfs.semanticscholar.org/00ec/92563697d2b9fcbfd62dc2f0a10ea126c4d0.pdf
12.Spontaneous Perinephric Haematoma In An Otherwise Healthy Adult Female
ABSTRACT : Spontaneous perinephric haematoma is a rare urologic entity. Tumours (both benign and malignant) are the most common causes. Several other causes have also been reported. However, in some patients, no apparent underlying etiology could be found and are described as having idiopathic spontaneous perinephric hematoma. We report a case of idiopathic spontaneous perinephric haematoma in a 38 year-old female who was successfully managed conservatively.
Key words: Haematoma, Perinephric, Spontaneous, Idiopathic.
Sharma A, Andankar M, Pathak H. Spontaneous Perinephric Haematoma In An Otherwise Healthy Adult Female.
https://www.researchgate.net/profile/Amit-Sharma-5/publication/320034017_Case_Report_Spontaneous_Perinephric_Haematoma_In_An_Otherwise_Healthy_Adult_Female_Spontaneous_Perinephric_Haematoma_In_An_Otherwise_Healthy_Adult_Female/links/59c9d067aca272bb0503e2b2/Case-Report-Spontaneous-Perinephric-Haematoma-In-An-Otherwise-Healthy-Adult-Female-Spontaneous-Perinephric-Haematoma-In-An-Otherwise-Healthy-Adult-Female.pdf
13.A case of cystitis cystica presenting as a bladder mass in a boy
Abstract Cystitis cystica is a rare proliferative lesion of the bladder, usually caused by chronic irritation and inflammation. It is caused by the hyperplasia of the submucosa and proliferation of von brunn nests of the bladder. Though usually benign, it is considered to have some malignant potential. This conditionhas been reported in adults, but is rarer in pediatric age group. We describe the case of cystitis cystica in a 13 year-old
Keywords Pediatric; hematuria; bladder mass; cystitis cystica.
Sharma A, Andankar M, Pathak H. Spontaneous Perinephric Haematoma In An Otherwise Healthy Adult Female.
https://www.pediatricurologycasereports.com/articles/a-case-of-cystitis-cystica-presenting-as-a-bladder-mass-in-a-boy.pdf
14.Papillary Renal Cell Carcinoma Presenting As Pyonephrosis In A Young Adult
ABSTRACT Papillary Renal Cell Carcinoma is the second most common type ofrenal malignancy in adults. It presents in fifth to seventh decade of life and is commoner in patients with End Stage Renal Disease and acquired renal cystic diseases. The presentation is similar to the clear cell type of Renal Cell Carcinoma and is asymptomatic usually. We report a case of Papillary Renal Cell Carcinoma in a young adult who presented with pyonephrosis.
Key words: Pyonephrosis, Papillary Renal Cell Carcinoma, Young Adult.
Sharma A, Andankar M, Pathak H. Papillary Renal Cell Carcinoma Presenting As Pyonephrosis In A Young Adult.
https://www.researchgate.net/profile/Amit-Sharma-5/publication/320033761_Papillary_Renal_Cell_Carcinoma_Presenting_As_Pyonephrosis_In_A_Young_Adult/links/59c9d00645851556e97a7bd0/Papillary-Renal-Cell-Carcinoma-Presenting-As-Pyonephrosis-In-A-Young-Adult.pdf
15.Intravesical Migration of an Intrauterine Contraceptive Device with Secondary Calculus Formation
Intrauterine contraceptive devices (IUCDs) are a common form of reversible contraception owing to fewer systemic side effects and low cost, especially in a developing country like India. However, IUCDs are not without complications. Migration of a device into adjacent organs is the most morbid of all the documented complications. A patient who presents with a history that suggests loss or disappearance of an IUCD thread associated with urinary symptoms should raise suspicions that a device may have migrated into the bladder. Physicians should also be aware of possible secondary vesical calculus formation. Further radiological investigations and appropriate management are warranted. We present a case report describing the migration of an IUCD into the bladder with secondary calculus formation.Migration of an intrauterine contraceptive device with secondary calculus formation. Korean journal of family medicine. 2017 May;38(3):163.
16.Hypospadias Repair Using Transverse Preputial Island Flap (Modified Asopa Procedure)
The modified Asopa's procedure for repair of hypospadias is well established and suited for patient characteristics for which Snodgrass urethroplasty cannot be done. We describe our experience with this procedure in 30 patients
managed this procedure highlighting the factors affecting outcome in this repair.
Materials and Methods: Data of 30 patients (age range 2.5-15 years) whounderwent hypospadias repair in a tertiary care teaching institution from 2012 to2015 with modified Asopa procedure (Hodgson XX technique) utilizing Transverse Preputial Island Flap by a single surgeon were reviewed and retrospectively analyzed according to age of patients, site of meatus, presence or absence or chordee, glans configuration and complications - fistula, glans dehiscence, meatal stenosis. These complications were further analyzed with respect to the various patient characteristics and GMS (Glans, Meatus and Shaft) score.Results: The mean age of presentation was 5.5 years and mean follow-up period was 22 months. The mean total GMS score was 8.5; range being 11 to 5. In total, only six patients had complications (20%). The patients with low GMS score (7 or less) had no complications. The complication rate wasmore in proximal hypospadias repair (n= 5/24) when compared with distal hypospadias (n=1/6). There were more complications in patients with chordee (n=4/6) and those with conical glans (n=4/6).Conclusion: Location of the meatus, presence/absence of chordee and glans configuration affect outcome in patients undergoing modified Asopa's procedure for hypospadias repair.Patil A, Sharma A, Mane N, Parab S, Andankar M, Pathak H. Hypospadias Repair Using Transverse Preputial Island Flap (Modified Asopa Procedure). Journal of Pediatric Nephrology. 2018 Oct 1;6(3):1-7.
https://iranjournals.nlai.ir/handle/123456789/725272
17.Percutaneous Nephrolithotomy in Pediatric age Group: Our Experience
Pediatric urolithiasis is an uncommon disease with incidence varying widely throughout the world. We present our experience in pediatric PCNL in 20 pediatric patients with urolithiasis.Materials and Methods: Case records of all patients under 14 years of age who presented with urolithiasis from 2016 Marchto February 2017 were retrospectively reviewed and analyzed with respect to demographic details, clinical presentation, stone characteristics, PCNL puncturesite, number, stone clearance, ancillary procedures used, complications, and follow-up status of the children. Associated biochemical abnormalities were alsoreviewed. Results: There were 25 renal units in 20 patients (5 had bilateral stones). The mean age at presentation was 8.4 years. There were 15 males and 5 females. The most common presenting symptom was flank pain (n=19/20).There were solitary stones in 17 renal units: 2 stones in 6 renal units and multiple stones in 2 renal units. The average stone size was 1.5cm. Four patients had staghorn calculi. Five patients required two punctures of whom 3 had bilateral disease and 2 had staghorn calculi. The sheath used ranged from
18 Fr to 22 Fr. The nephrostomy tube and DJ stent were kept in all patients.Theduration of the procedure at a single site ranged from 45 minutes to 75 minutes.Complete clearance was achieved in 19 patients while one patient required bilateral URS. Three patients had mild fever post-operatively. None of the patients required blood transfusion. Hypocalcaemia was detected in 7 patients.Conclusions: PCNL is safe and effective for treating urolithiasis in children.
Sharma A, Parab S, Goyal G, Jadhav S, Andankar M, Pathak H. Percutaneous nephrolithotomy in pediatric age group: our experience. Journal of Pediatric Nephrology. 2019;6(3):1-4.
https://iranjournals.nlai.ir/handle/123456789/725271
18.Metabolic Evaluation in Pediatric Urolithiasis: Our Experience
Introduction: Pediatric urolithiasis is a morbid condition that is often associatedwith underlying metabolic disorders. It is essential to diagnose and manage theunderlying metabolic disorder along with management of urolithiasis to preventstone recurrence and decrease the morbidity.
Materials and Methods: This retrospective observational study was conducted in50 patients below 15 years of age with urolithiasis. Urine collection was done for24 hours in toilet-trained children and spot samples were taken from youngerchildren. The urinary parameters that were evaluated included calcium, oxalate,citrate, uric acid, and total urine volume. The serum levels of calcium,phosphorus, creatinine, uric acid, electrolytes, parathormone, and albumin werealso measured. Stone analysis was done whenever possible.
Results: There were 32 males and 18 females. Sixty-two percent of the patientshad a low calcium intake and 70% of the children had a history of low water intakeand had a low urine volume over 24 hours. Half of the children had serummetabolic abnormalities, including hypocalcaemia (n=19,38%), hypocalcaemiawith hyperphosphatemia (n=2, 4%), hypercalcemia (n=2, 4%), and hyperuricemia(n=2,4%). Urinary abnormalities were detected in 42% of the children (n=21).These abnormalities included hypocitraturia in 11 patients (50%), hypercalciuriain 7 patients (30%), hyperoxaluria in 1 patient (6%), and hyperuricosuria in 2patients (12%). Stone analysis was done in 18 patients. Fifteen patients (30%)had calcium oxalate stones, two patients (4%) had uric acid stones, and onepatient had a mixed stone.
Conclusions: It is important to maintain an optimal blood calcium level andincrease fluid intake to prevent stone formation in children.Keywords: Urolithiasis; Pediatric; Metabolic Disorders.
Gadekar C, Sharma A, Parab S, Mane N, Andankar M, Pathak H. Metabolic Evaluation in Pediatric Urolithiasis: Our Experience. Journal of Pediatric Nephrology. 2018 Jan 1;6(1).
https://journals.sbmu.ac.ir/jpn/article/view/17630
19.Endoscopic management of massive stone load in a patient with repaired bladder exstrophy
Bladder exstrophy is a rare congenital malformation of the genitourinary system.Patients with exstrophy of the bladder who have undergone augmentation cystoplasty with Mitrofanoff procedure have a tendency of recurrent calculi formation. A 23-year-old female, with bladder exstrophy, underwent Mitrofanoff procedure and developed recurrent vesical calculi thereafter. She presented to us with a very massive stone load, which was managed successfully by endoscopic technique. She was also taught preventive measures thereafter andadvised regular follow-up. The importance of the report is that it highlights urolithiasis as a recurrent complication of primary bladder exstrophy closure, which can be managed effectively and safely by modern endoscopic techniquesin a hostile abdomen with reconstructed tract and inaccessible urethra.
Agarwal VV, Andankar MG, Pathak HR. Endoscopic management of massive stone load in a patient with repaired bladder exstrophy. Arch Int Surg 2018;8:38-40
https://www.archintsurg.org/article.aspissn=2278-9596;year=2018;volume=8;issue=1;spage=38;epage=40;aulast=Agarwal
20.The use of gracilis muscle flap as a cover of tabularized buccal mucosal graft in the posterior urethral injury
This is a case report of 35-year-old male patient, who underwent abdominoperineal resection for rectal cancer. There was postoperative wound complication which resulted in the formation of sinus in the perineal wound. During excision of the sinus tract, there was injury to the posterior urethra whichleads to the formation of urethrocutaneous fistula presenting as urinary incontinence. These findings were confirmed by ascending urethrogram and cystoscopy. We describe the use of gracilis muscle flap as support and cover for buccal mucosal graft which has been used for the repair of the posterior urethral injury. On removal of Foley's catheter after 3 weeks of the surgery, there was no leakage of urine from the perineal wound, and the patient was continent. The highly vascularized muscle flap is beneficial in patients with a
poor graft bed secondary to prior radiotherapy, avoiding urinary diversion in most patients.
Parab SV, Goyal G, Jadhav S, Pathak H, Andankar M, Gadekar C. The use of gracilis muscle flap as a cover of tabularized buccal mucosal graft in the posterior urethral injury. Urology annals. 2020 Apr;12(2):176.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292441/
21.Safety and Efficacy of Trans-Perineal Urethroplasty for Management of Post-Traumatic Urethral Strictures in Pediatric Age-Group
Trans-perineal urethroplasty is the preferred treatment for distraction urethral injuries in adults. However, management of such injuries in children is challenging because of functional implications in a growing child. In the present study, we aim to evaluate the safety and efficacy of perineal urethroplasty for distraction urethral injuries in children. The medical records of prepubertal pediatric patients (age <14 years) with traumatic urethral distraction injuries managed by perineal urethroplasty were retrospectively reviewed and analyzed with respect to demographics, stricture characteristics, management, complications, follow-up, and outcome.
Chaudhari R, Sharma A, Shaikh I, Andankar M, Pathak H. Safety and Efficacy of Trans-Perineal Urethroplasty for Management of Post-Traumatic Urethral Strictures in Pediatric Age-Group. Urologia Internationalis. 2021 Apr 13:1-5.
https://www.karger.com/Article/Abstract/515612
22.Urodynamic evaluation of urinary disturbances following traumatic brain injury
Objectives: To identify the incidence and the type of voiding dysfunction by doing urodynamic studies (UDS) in head injury patients. The purpose of this paper is to present our findings and promote research in this field.
Patients and methods: A prospective study was conducted recruiting patients sustaining head injuries with positive CT scan findings. Clinical and radiological evaluation was done. Patients then underwent standardized UDS. The urodynamic findings were correlated with outcome and analyzed.
Results: Three out of 11 patients (27.3%) had unstable bladder with multiple involuntary contractions in the filling phase. All of them had significant contusions in the right frontal region and 2 of them had subarachnoid hemorrhage. All of these patients had normal proprioception, voluntary detrusorcontractions and nil post-void residue. Two out of the 3 patients had catheter in situ and 1 patient had complaints of frequency and urgency. At 1 year of follow-up, all 3 patients had a normal voiding pattern and the upper tracts were normalon ultrasound in all patients.
Conclusions: Voiding dysfunction is a significant problem in patients with head injury. Bladder hyperreflexia is seen in patients with injuries above the pontine micturition center. The voiding abnormality has good prognosis and resolves spontaneously. Treatment in the acute phase may require anticholinergics for a few months.
Urodynamic evaluation of urinary disturbances following traumatic brain injury. Urol Int. 2011;84(1):89-93. Epub 2010 Feb 17.
https://pubmed.ncbi.nlm.nih.gov/20173376/
23.A single-centre experience of the management of inguinal lymph nodes associated with penile squamous-cell carcinoma
Background: Twenty-two cases of penile carcinoma that were managed at our institution over a 5-year period were analysed on the basis of inguinal lymph node dissection (ILND), complications and follow-up. Methods: A total of 22 cases post penectomy were stratified into low risk (T1 G1 or G2 without lympho-vascular invasion and negative on fine-needle aspiration cytology (FNAC)) and high risk (T1 G3 and above and/or lympho-vascular invasion). Low-risk patients having palpable lymphadenopathy were given a course of antibiotics. If the lymph nodes were still palpable, FNAC was done, and patients then underwent superficial ILND (SILND) or even ILND in cases with positive frozen-section reports. In the high-risk group, all patients underwent SILND, and if required, underwent ILND. Two patients in the high-risk group were lost to follow-up after 9 months. Histopathology reports were noted, and patients were followed up for 2 years. Results: In the low-risk group, seven patients had palpable lymph nodes and underwent SILND. The remaining five patients were put on surveillance. Amongst the seven who underwent SILND, six were positive at frozen section, requiring ILND. Nine patients in the high-risk group underwent ILND. Four patients in the ILND group had a minor wound infection. Lymphoedema was seen in two patients which was managed conservatively, and lymphorrhoea was seen in one patient. Flap necrosis occurred in one patient. Recurrences were seen in three patients in the high-risk group. Two who had deep node involvement and who had early nodal recurrence underwent bilateral ILND. One patient in the high-risk group had late ipsilateral nodal recurrence and underwent ipsilateral ILND. There were no regional recurrences. Conclusion: Carcinoma of the penis has high morbidity because of delayed presentation, lack of awareness and poor compliance. This necessitates staging SILND in all high-risk cases for therapeutic and prognostic purposes.
Sharma A, Parab S, Goyal G, Patel A, Andankar M, Pathak H. A single-centre experience of the management of inguinal lymph nodes associated with penile squamous-cell carcinoma. Journal of Clinical Urology. 2020 Jul 7:2051415820939407
https://journals.sagepub.com/doi/abs/10.1177/2051415820939407
24.Does site of buccal mucosa graft for bulbar urethra stricture affect outcome? A comparative analysis of ventral, dorso-lateral and dorsal buccal mucosa graft augmentation urethroplasty
Objective
To compare long- term outcomes of buccal mucosa graft (BMG) augmentation urethroplasty for long segment bulbar urethral strictures done by placing the graft ventrally, dorso-laterally and dorsally.
Material and methods
We conducted a single institution retrospective study on 112 who underwent BMG augmentation urethroplasty for non-traumatic bulbar urethral strictures between January 2005 to December 2014. The cases were divided into three groups based on the site of placement of BMG graft i.e. (a) Ventral (n=44), (b) Dorso-lateral (n=48) and (c) Dorsal (n=20). Follow-up period was from one year to five years. Patients with failed outcomes underwent urethroscopy or retrograde urethrogram to note the site of recurrence of stricture.
Results
Out of 112 cases 91 (81%) were successful and 21 (19%) failed. The success rates for ventral, dorso-lateral and dorsal BMG augmentation procedures were 89%, 79% and 70%, respectively (p=0.18). Among 21 failed cases, 12 cases (57%) had stricture at proximal anastomotic site, 4 cases (19%) at graft and 5 cases (24%) at distal anastomotic site (p=0.01).
Conclusion
The overall success rate for BMG augmentation urethroplasty is equal for all techniques. Ventral onlay urethroplasty provides better exposure of proximal anastomotic site thus it is associated with minimum proximal anastomotic site recurrence rates. Patients with extensive spongiofibrosis and long segment strictures had higher rates of failure.
Does site of buccal mucosa graft for bulbar urethra stricture affect outcome? A comparative analysis of ventral, dorso-lateral and dorsal buccal mucosa graft augmentation urethroplasty. Trk rolojiDergisi/Turkish Journal of Urology. 43. 10.5152/tud.2017.30771. (2017).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5562257/
25.Comparison of contrast-enhanced voiding urosonography with voiding cystourethrography in pediatric vesicoureteral reflux
Objective
Voiding cystourethrography (VCUG) has been considered as the gold standard technique for the diagnosis of vesicoureteral reflux (VUR). But, it requires fluoroscopic guidance which expose children to radiation. Voiding urosonography (VUS) is technically analogous to VCUG and has the major advantage of zero radiation exposure. This study aims to determine the efficacy of contrast enhanced-VUS (ce-VUS) with respect to VCUG in diagnosing VUR.
Material and methods
This study involves 30 children over a period of 3 years. All patients underwent a VCUG followed by the ce-VUS on the same day. All VUS studies were done by the same sonologist in the sonography department. The images were recorded and reviewed by the same sonologist before reporting.
Results
The median age of the patients was 51.53 months. There were 21 males and 9 females. On VCUG, 16 patients had no reflux, and 14 patients had reflux. On ce-VUS, 14 patients had no VUR, and 16 patients had VUR. Of the total 58 kidney-ureter units (KUUs), VUR was detected in 17 KUUs on VCUG and in 21 KUUs on ce-VUS. Thus, ce-VUS detected 4 refluxing units that were not seen on VCUG. In right KUUs, ce-VUS detected VUR in 3 units where no reflux was found in VCUG. In the 28 left KUUs, 25 units on ce-VUS showed concordance with the grade of VUR as detected by VCUG; 3 were discordant. Two units on ce-VUS showed a VUR one grade higher than the corresponding grade on VCUG and in one unit it was one grade lower. Thus, in total, ce-VUS picked up 4 cases which were missed by VCUG.
Conclusion
ce-VUS is a good imaging modality when compared to voiding cystourethrography to assess pediatric vesicoureteral reflux, in view of its superior diagnostic performance, feasibility and radiation safety for children.
Comparison of contrast-enhanced voiding urosonography with voiding cystourethrography in pediatric vesicoureteral reflux. Trk rolojiDergisi/Turkish Journal of Urology. 44. 10.5152/tud.2018.76702. (2018).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937646/
26.Adult Wilms Tumour
Adult Wilms Tumour. Journal of clinical and diagnostic research : JCDR. 10. PJ01-PJ02. 10.7860/JCDR/2016/18010.7385. (2016).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843326/#!po=68.1818
